Healthcare Provider Details

I. General information

NPI: 1134276025
Provider Name (Legal Business Name): TIMOTHY HOFELDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

IV. Provider business mailing address

2458 NW HEMMINGWAY ST
BEND OR
97701-1100
US

V. Phone/Fax

Practice location:
  • Phone: 541-322-7500
  • Fax:
Mailing address:
  • Phone: 615-480-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD150323
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: